No new help available

The worst part of being a medical journalist is not the long hours researching and writing a column or the never-ending deadlines week after week. It's when the written word becomes too authoritative and readers think you know more than you do -- and you simply cannot deliver the goods.

A few weeks ago that scenario happened. A young woman wrote that she suffered from Crohn's disease. She had been hospitalized 30 times, endured several operations and had been treated by a variety of medications. Yet her life was still a living hell. She asked if I had any way to help her.

Crohn's disease is an inflammation of the digestive system. It affects one million patients in the U.S. and 100,000 Canadians. Although it's a serious disease, it isn't considered fatal.

We don't know why it affects more women than men, but it normally develops in the teens or 20s and it can strike after age 50.

Patients with Crohn's disease usually complain of abdominal pain, diarrhea, weight loss, fever and often blood in the stool.

But the symptoms ebb and flow with periods of relative inactivity. In fact, some patients may be free of symptoms for years.

Crohn's disease may affect any part of the intestinal tract, but usually strikes either the large or small bowel or sometimes both.

A colonoscopy, a flexible lighted optical instrument to inspect the entire large bowel, is used to diagnose this condition. In addition, a GI series, in which patients swallow a chalky barium solution, helps to pinpoint the problem.

But it's the repeated inflammatory hits that take a toll on the bowel's wall. Eventually, a cobble-stone thickening of the intestines may result in a bowel obstruction.

Other patients may develop intestinal ulcers, infections and fistulas. A fistula is an abnormal passage between organs. And some patients may be troubled by eye infections, arthritis and skin eruptions.

We don't know what causes this disease, but genetic factors are at work. For instance, patients who have a relative with Crohn's disease are 10 times more likely to develop this problem. And should the relative be a sibling, the risk increases to 30 times.

Some researchers believe Crohn's disease may be an autoimmune disorder, a disease, like rheumatoid arthritis or lupus, in which the body defence mechanism gets confused and starts to attack its own cells.

Is it possible that a virus or bacterial infection could play a role? Some researchers believe this may be the case and several organisms have been implicated.

One bacterium, called mycobacterium paratuberculosis, causes what's called "Johne's disease" in cattle, sheep and goats. The germ is excreted in the milk of infected cattle. Some studies show it may survive pasteurization.

So far the bacterium has been found in some patients suffering from Crohn's disease. In a small clinical study there was a 50% remission rate in patients given antibiotics.

Dr. Michael Collins, a doctor of veterinary medicine at The University of Wisconsin, is examining the possibility that this organism could be transferred through the food chain.

Using a specific DNA probe for mycobacterium paratuberculosis, researchers have isolated the organism in 46% to 72% of Crohn's patients.

But simply finding an organism in patients with Crohn's disease does not mean it's the cause of this disorder.

The treatment depends on the severity of the disease. Some patients find that avoiding certain foods decreases the risk of attacks. High-fibre foods, milk, alcohol and hot spices are often related to recurrent symptoms.

But the primary approach is drug therapy, such as corticosteroids and others, in an endeavour to limit the inflammatory process. If additional control is needed, drugs to suppress the immune system are prescribed.

Surgery is required for bowel obstruction or other complications, such as the development of fistulas. Studies show that 50% of patients who have had surgery require another operation in 10 years and 75% need it after 15 years.

This week I feel particularly humble. I had no magic therapy that hasn't already been tried to send along to my reader. How I wish I were wiser than I am.